Time Course of Body Composition Changes in Transgender Adolescents During Puberty Suppression and Sex Hormone Treatment

Changes in physical fitness in transgender adolescents receiving gender-affirming hormone therapy: protocol for a prospective cohort pilot study

There is very little data about the physical fitness of transgender and gender-diverse (TGD) youth. This protocol paper describes the methods for a pilot study that aims to measure changes in fitness levels in TGD adolescents undergoing gender-affirming hormone therapy (GAHT) using FitnessGram, a reliable, validated tool used to measure physical fitness. A secondary aim of the study is to compare the physical fitness of TGD adolescents with normative data for cisgender individuals. This will be a prospective cohort study. We will recruit 25 TGD participants who are 13-18 years old and patients in our organisation's Gender Development Clinic, planning to initiate GAHT. Participants will complete FitnessGram before starting GAHT and undergo repeat assessments 6 months and 12 months after GAHT initiation. Participants will also complete the Physical Activity Questionnaire for Adolescents. We plan to report changes in the participant's ability to achieve the FitnessGram standards over 12 months. Secondary outcomes will include a comparison of the achievement of the FitnessGram standards in the cohort with the reported achievement of standards for cisgender adolescents.

Puberty suppression in adolescents with gender dysphoria: an emerging issue with multiple implications

Controversy exists over puberty suppression (PS) in adolescents with gender dysphoria (GD). PS is preferentially achieved with GnRH analogues. By preventing the development of secondary sex characteristics, PS may improve psychological functioning, well-being, quality of life, emotional and behavioral (especially internalizing) problems and depressive symptoms, thus decreasing suicidality. PS can also extend the diagnostic period and give transgender adolescents time to explore their gender identity. GnRHa may also decrease the need for feminization/masculinization surgery. However, 2-year treatment with GnRHa may result in bone mass accrual retardation (decrease in BMD/BMAD z-scores), growth velocity deceleration (decrease in height SDS), increase in fat mass, temporary pause in oocyte/sperm maturation. The most common side effects of GnRHa are hot flashes, mood fluctuations, fatigue and headache. They are usually mild and rarely lead to GnRHa discontinuation. Based on current scientific evidence, PS could be recommended to adolescents who meet the diagnostic criteria of gender incongruence (by DSM-5 and/or ICD-11) and have long-lasting intense GD, which aggravates with puberty onset. Before initiating PS, possible mental issues should be addressed and informed consent (by the adolescent/caregiver) should be given, after counseling on probable reproductive effects of GnRHa. GnRHa can only be started after the adolescent has entered Tanner stage 2. Nevertheless, published studies are inadequate in number, small in size, uncontrolled and relatively short-term, so that it is difficult to draw safe conclusions on efficacy and safety of GnRHa. Large long-term randomized controlled trials are needed to expand knowledge on this controversial issue and elucidate the benefit and risks of PS.